QUESTION

When I went to the pharmacy to get fill my birth control, I had a co-pay. I thought all contraceptive coverage had to be free?

Post enrollment issues | Employer-Sponsored Coverage
ANSWER

In general, health plans must cover all 18 methods of contraceptive coverage that the FDA has currently approved unless the health plan is grandfathered. The list of approved contraceptive methods is available here. While health plans must cover all 18 methods, they are not obligated to cover each form of contraception under each method. For example, if a health plan covers both a generic and brand name birth control pill, it can impose cost-sharing on the brand name over the generic as part of its medical management. However, if your doctor determines you should take the name brand birth control because it’s medically appropriate, the health plan must cover the brand name birth control without cost sharing.

Note that a recent change in federal rules allows an employer or an insurer that has an objection based on “sincerely religious beliefs or moral convictions” to exclude some or all contraceptives from a health plan. However this exemption is being legally challenged and the new regulation has not yet become effective. If it does become effective, contraceptive benefits will vary depending on the policy and state laws.

This is an area that is constantly evolving. If you have a question, you should ask your employer or insurer what is covered or contact the National Women’s Law Center via information here if your employer or insurer says contraception is not covered. (CMS, ACA Implementation FAQs-Set 26, May 11, 2015).

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